Coyle Doug
School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cres, Ottawa, ON, K1G 5Z3, Canada.
Health Economics Research Group, Department of Health Sciences, Brunel University, London, Uxbridge, UK.
Health Econ Rev. 2024 Nov 13;14(1):90. doi: 10.1186/s13561-024-00556-w.
When decision-makers use economic evaluation to facilitate making decisions about reimbursing whether to reimburse pharmaceuticals within a publicly funded health care system, they may consider whether to prioritise specific patient populations or diseases: e.g., cancer or rare disease. This can be achieved through applying equity weights to outcomes such as QALYs. Decision makers, however, must choose whether equity weights are applied to solely the treatment of a specific disease or to treatments of the patient with the specific disease. Without such clarification, confusion may arise which can hinder the work of those who must make reimbursement recommendations and decisions. This study examines the repercussions of implementation of equity weights. For illustration, two hypothetical case studies relating to a rare disease are considered. The first case study demonstrates that applying equity weights only to the treatment of the rare disease of interest can lead to a patient with that rare disease accruing less benefits at a higher cost to the payer. The second case study demonstrates that if equity weights are applied to the patients who have a specific rare disease, then funding of a treatment for a common disease may be restricted only to those patients for whom treatment is more costly and less effective. As discussions continue with respect to applying equity weights within economic evaluation, it is important that the repercussions outlined are recognised.
当决策者运用经济评估来协助做出关于在公共资助的医疗体系中是否报销药品的决策时，他们可能会考虑是否优先对待特定患者群体或疾病，例如癌症或罕见病。这可以通过对诸如质量调整生命年（QALY）等结果应用公平权重来实现。然而，决策者必须决定公平权重是仅应用于特定疾病的治疗，还是应用于患有该特定疾病患者的治疗。如果没有这种明确说明，可能会产生混淆，这会妨碍那些必须做出报销建议和决策的人的工作。本研究考察了公平权重实施的影响。为了说明，考虑了两个与罕见病相关的假设案例研究。第一个案例研究表明，仅对所关注的罕见病治疗应用公平权重，可能导致患有该罕见病的患者获得的益处更少，而付款人的成本更高。第二个案例研究表明，如果对患有特定罕见病的患者应用公平权重，那么对一种常见疾病治疗的资金可能仅会提供给那些治疗成本更高且效果更差的患者。随着关于在经济评估中应用公平权重的讨论不断进行，认识到上述影响很重要。
